Patient incentive programs: A compliance-centered guide for healthcare marketers
By Abby Quillen●7 min. read●Feb 27, 2026
Daily behaviors are the single biggest contributor to a person’s health. They have a greater impact than genetics, environment, and social determinants, according to the World Health Organization. That makes helping people change their behaviors one of the most important facets of healthcare — and incentives can play a key role.
Studies show that incentives can encourage patients to undergo preventive care like cancer screenings and annual physicals, increase physical activity, and stay on track with treatment plans. At the same time, incentives can help direct-to-consumer health and wellness brands increase long-term engagement.
While many patients and customers respond to well-designed incentives, federal and state regulations create compliance risks for healthcare marketers. This guide explores how to offer compelling incentives that motivate healthy patient behaviors without creating legal or regulatory issues.
What are patient incentive programs and why do they work?
Patient incentives are financial rewards like gift cards, discounts, or other items of value offered to patients to encourage specific health behaviors. A systematic review of medical studies shows they can improve enrollment, engagement, and retention across varied health promotion programs.
Behavioral economics sheds light on why incentives work. This discipline looks at how small cues, or nudges, in the external environment trigger people to change behavior. Without incentives, people often prioritize immediate convenience and undervalue the future health benefits of making a change. But an immediate incentive can motivate them to make a behavior change that benefits them in the long run.
Incentives don’t just work for patients. They can also help health and wellness brands stand out in a crowded competitive landscape. The U.S. health and wellness market exceeds $2.31 trillion, with an expected compound annual growth rate of 5.4%. Today, consumers have their pick of more than 350,000 mobile health apps. In this saturated market, incentives give patients a reason to choose and stick with your business over time.
Types of patient incentive programs
Depending on the services or products your company or practice offers, you may be able to implement different types of incentive programs. Direct-to-consumer products and services typically have more flexibility in program design and reward amounts. Services covered by traditional health insurance, especially government programs like Medicare and Medicaid, are often subject to stricter regulations. (More on this in the next section.)
Here are a few common types of patient incentive programs, why they matter, and what the evidence shows about their benefits.
Preventive care and screening completion programs
Why incentives matter: Even when screenings are covered by insurance and widely recommended, many people put them off. More than a quarter of Americans aren’t up to date with recommended health screenings.
What the evidence shows: Multiple studies suggest incentives encourage patients to take part in vaccination programs and cancer screenings. Preventive care also has the clearest compliance path.
Medication adherence and chronic disease management programs
Why incentives matter: Up to half of patients don’t fill or take prescriptions as directed. Medication user errors account for up to 10% of hospital readmissions.
What the evidence shows: Research shows incentives can encourage patients to refill and take their medications, although the effects may be short-term. In one study, financial incentives encouraged 85% of patients to take a medication compared to 71% in a control group. But the behavior change didn’t last after the incentive ended.
Onboarding and activation incentives
Why incentives matter: When patients have more knowledge about their health and are more involved with their care, they tend to have better clinical outcomes. Unfortunately, 25% to 40% of patients have low knowledge, skill, or confidence related to their care.
What the evidence shows: Studies suggest incentives encourage patients to have more involvement in their care. In one study, patients were more likely to talk to their doctors about a treatment when they received a financial incentive in addition to a letter and phone call. A meta-analysis of studies suggests that incentivized patients are also more likely to attend mental health treatment.
Appointment completion incentives
Why incentives matter: Missed appointments are common. Patients miss out on care, and no-shows can be costly for healthcare providers.
What the evidence shows: Incentives can encourage patients to show up for their appointments. In one study, patients attended 72.7% of appointments when given a financial incentive compared to 61.2% in the control group.
Patient referral programs
Why incentives matter: It costs medical practices between $203 and $610 to attract and acquire a new patient. People are more likely to trust recommendations from people they know, making referrals a cost-effective way to grow your patient or customer base.
What the evidence shows: Referral programs can potentially offer a strong return on investment because customers acquired through referrals make 31% to 57% more referrals than non-referred customers. But referral offers need to comply with relevant regulations.
Patient feedback programs
Why incentives matter: Patient experience surveys allow practitioners to refine their approaches and services. Plus, value-based care ties surveys directly to a health system’s bottom line. Unfortunately, survey response rates are often low. In one study, only 13% of patients responded to a mailed survey with a telephone follow-up, and an even lower percentage responded to a web-based survey.
What the evidence shows: Incentivized patients are more likely to complete patient surveys. A systematic review of studies shows that even small incentives can improve response rates.
Incentive compliance framework
Before your marketing team launches an incentive program, it’s important to understand federal rules that limit incentives for products or services billed to insurers. Companies that sell direct-to-consumer products or provide services paid out of pocket by patients have more freedom to experiment with incentives.
Regulations for insurer-reimbursed programs
Federal anti-kickback laws are designed to ensure patients get the care they need instead of paid recommendations. While they’re meant to prevent misaligned provider and manufacturer behaviors, they may limit well-intentioned patient incentive programs. Here’s a quick breakdown of the rules.
The Anti-Kickback Statute (AKS)
This law makes it a federal crime to offer or receive anything of value in exchange for referrals for items or services covered by federal healthcare programs. The penalties can include up to $100,000 in fines, 10 years in prison, and possible exclusion from Medicare or Medicaid programs.
The Eliminating Kickbacks in Recovery Act (EKRA)
This law prohibits offering or receiving anything of value for referring laboratories, clinical treatment facilities, or recovery homes, whether covered by federal programs or commercial health plans. Penalties can include up to $200,000 in fines and 10 years in prison.
The Beneficiary Inducement Prohibition
Part of the Civil Monetary Penalty Law, this rule stops health centers from offering anything of value to Medicare, Medicaid, or CHIP patients if it’s likely to influence their choice of providers or services. While not a criminal law, penalties can exceed $24,000 per violation and up to three times the federal program reimbursement rate.
State fraud and abuse laws
Most states have laws against offering incentives to patients covered by Medicaid or Medicare. Some states extend these rules to private insurers as well as government programs. The penalties vary, so it’s important to check your state’s rules.
Key safe harbors and exceptions
Even if you serve Medicare or Medicaid patients, you can still offer rewards as long as you align them with existing regulatory exceptions and safe harbors. Here are some of the main ones.
Nominal value exception
Small, non-cash incentives are usually okay. Each incentive must be worth less than $15 per item and can’t exceed $75 total per person per year. Programs must offer gift cards or vouchers that can only be redeemed for a smaller category of services or items, such as meal delivery, gas, or a taxi ride. The incentives can’t be cash, checks, prepaid cards, or gift cards for large retailers that sell a wide variety of items.
Preventive care exception
Incentives for preventive services recommended by the U.S. Preventive Services Task Force, as well as prenatal care and well-baby visits, are generally allowed. But they must only promote the specific preventive service, not any other services reimbursed by Medicare or Medicaid. They also can’t be cash or cash equivalents.
Centers for Medicare & Medicaid Services (CMS)-sponsored model patient incentives
Participants in a CMS-sponsored model, including programs like the Medicare Shared Savings Program (MSSP), may be allowed to offer patient incentives specifically authorized under the model.
Contingency management programs
Evidence-based programs for substance use disorders can include financial incentives to reward healthy behavior, such as staying in treatment or remaining abstinent. These programs can be compliant as long as they follow specific limits and documentation requirements.
How to send patient incentive programs at scale
Now that you understand the federal rules around offering incentives, it’s time to design your program. Using an incentive platform makes it easy to send incentives at scale while staying compliant with federal regulations.
Signs it may be time to partner with an incentive platform
If you only send a few incentives a year, you may be able to send them manually. But as your program grows, it can become overwhelming to juggle distribution, tracking, and compliance. You may want to look into a platform if you:
Send lots of rewards: If you’re distributing rewards to hundreds or thousands of patients a year, a platform can streamline fulfillment and tracking.
Offer multiple incentive types: A platform makes it easier to offer and manage a variety of reward options.
Send frequent rewards: For recurring or high-value incentives, a platform can automate W-9 collection and 1099 reporting.
Run cross-team programs: When multiple departments or teams run incentive programs, a platform provides centralized oversight and documentation.
What to look for in a platform
Once you’re ready to bring on a platform, here are some key features to look for:
Compliant digital delivery: The ability to send digital gift cards at scale in a way that supports anti-kickback compliance
Individual-level tracking: A clear record of each patient’s incentive history to support transparency and compliance
System integration: APIs or webhooks to connect your CRM or patient engagement system and automate payouts
Built-in audit trails: Reports and dashboards to support internal reviews and external audits
Tax reporting support: Automated tax-form collection for high-volume or large incentives
[Optional] Global support: Local reward, currency, and language support for customers in different countries (if relevant)
Measuring ROI on patient incentive programs
Once you’ve established your program, you need to know whether it’s working. Set up tracking before you launch to establish clear baseline measurements for meaningful comparison. The following data points will help you understand your program’s performance:
Appointment completion and no-show rates: Show whether incentives are motivating patients to attend their scheduled visits.
Milestone achievements for goal-based programs: Indicate whether incentives are encouraging patients to engage more actively in their care.
Patient retention and lifetime value: Measure ongoing loyalty and engagement across all incentive program types.
Referral volume and new patient acquisition cost: Demonstrate whether incentives are helping attract new patients or customers.
Net Promoter Score (NPS) or patient satisfaction scores: Assess whether incentives are improving the overall patient experience.
Attributing outcomes to incentives can be tricky since patients are influenced by many different factors in their experience with your brand. Patients may engage with emails, advertisements, your website, and in-person staff, which can all influence their behavior. To isolate the impact of incentives, consider using A/B testing to compare results against a control group that doesn’t receive them.
Summary
Incentive programs can make a meaningful difference for customers while helping your health company grow. If you’re ready to start an incentive program, keep these points in mind:
Patient incentive programs work: Research shows that well-designed incentives can encourage behavior change by helping attract patients and motivate them to stick to healthy habits or treatment recommendations.
Federal rules limit incentives: If you offer products or services billed to insurers, you must structure rewards carefully to comply with safe harbors and other rules.
Incentive platforms simplify compliance: The right platform can help you deliver compliant rewards, generate audit-ready documentation, and automate tax reporting.
Track the right metrics to measure ROI: Measuring appointment completion, referral volume, patient satisfaction, and other data points will help you gauge the impact of your program so you can use your budget on initiatives that deliver the best ROI.
